Rahul K. Shah, MD, FAAP, FACS

Dr. Shah obtained his BA/MD from Boston University and completed his Otolaryngology residency at Tufts University followed by a fellowship in Pediatric Otolaryngology at Children's Hospital Boston at Harvard University. After fellowship, he joined the faculty of Children's National Medical Center in 2006. Dr. Shah is an active clinical researcher and has received numerous awards for his research.

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

Sinus surgery facts

Balloon sinuplasty or sinus ostial dilation surgery is a newer method to address sinus disease. It involves expanding the natural drainage openings of the sinus passages. It is an approved, safe procedure that may be done in the operating room or office setting for some patients.

There are many risks and complications of sinus surgery; failure to resolve infection, recurrence of the original sinus problem, bleeding, chronic nasal drainage, failure to resolve all original sinus problems, damage to the eyes or base of the skull, pain, reduction or loss of sense of smell or taste, or the need for additional surgery and medical consultations.

If the sinus surgery is in the operatiung room with general anesthesia:

Prior to surgery, the patient needs to refrain from food and drink for 8 hours, have no fever, and arrange for someone to bring the patient to and from the hospital

On the day of surgery, the patient should have all paperwork and meet the anesthesiologist; the patient should only take the medication approved by the surgeon and anesthesiologist.

The surgery may take several hours.

After sinus surgery, most patients can go home accompanied by a friend or relative; bed rest with the head elevated is recommended along with an ice pack wrapped in a towel to stop any bleeding that commonly occurs.

Recovery may take about 3 to 5 days; patients should take their prescribed medications and avoid any strenuous activities until cleared to do so by the surgeon.

Follow-up care is critical for recovery; keep all appointments and follow instructions in regard removing nasal packing and especially instructions on nasal irrigation (many surgeons request patients to remain in the area for 3 weeks after surgery in case any problems develop).

Notify the surgeon for excessive bleeding, fever greater than 101.5 F (38.6 C) that persists even with Tylenol use, sharp pain or headache not responsive to medications, increased swelling of nose or eyes and thin clear fluid draining from the nose.

Self-care and prevention of complications include maximizing moisture in the nose (moisturize frequently), moisturizing sprays such as "Ocean Spray" are useful), avoid allergens, colds and the flu (make sure flu shots are up-to-date).

If the sinus surgery is in the office-based setting or the balloon sinuplasty method is used, the surgeon and clinical team may have you refrain from eating and drinking if sedation is used. In some cases, the procedure may be done under local anesthesia only.

Recovery on the day of balloon sinuplasty is usually quicker than with general anesthesia. The post-operative recovery will also take several days, include nasal irrigation, and include follow-up in the office.

It is important to note that balloon sinuplasty has not been shown to be superior to traditional sinus surgery regarding the long-term outcome for patients and the elimination or recurrence of disease.

What is sinus surgery?

Traditional sinus surgery involves the precise removal of diseased sinus tissue with improvement in the natural drainage channels by the creation of a pathway for infected material to drain from the sinus cavities. In most situations, the surgeon will employ endoscopic techniques which allow better and more precise visualization without the need for external incisions. As a result, there is less swelling, bleeding, and discomfort, and a faster recovery from sinus surgery.

Sinus surgery, unlike other types of surgery where a diseased part or organ is removed, involves the re-routing of existing sinus pathways in addition to removal of diseased tissue. It cannot be emphasized more strongly that post-operative care is as equally important as the surgery itself. One of the most common causes of failure of this procedure is poor post-operative care and follow-up. The doctor can only do so much. It is up to the patient to share in the responsibility of caring for this chronic illness. The following instructions are designed to help patients recover from sinus surgery as easily as possible and to prevent complications. It is very important that patients read these instructions or those provided by their surgeon and follow them carefully.

The following information is provided to help individuals prepare for sinus surgery and to help them understand more clearly the associated beliefs, risks, and complications of sinus surgery. However, people are encouraged to ask their doctor any questions to help them better understand the procedure.

Picture of the anatomy of the sinuses

Picture of the detail of the sinuses

What are the risks and complications of sinus surgery?

The following complications of sinus surgery have been reported in the medical literature. This list is not meant to be inclusive of every possible complication. It is here for patient information only - not to make patients overly concerned - but to make them aware and more knowledgeable concerning potential aspects of sinus surgery. The surgeon will review the risks and benefits of the surgery when obtaining consent for the operation, and will be able to discuss the chance of these complications with respect to an individual's potential risks of surgery at that time.

Failure to resolve the sinus infections or recurrence of sinus problems and/or polyps.

Bleeding. In very rare situations, a need for blood products or a blood transfusion may be required. Patients have the right, should they choose, to have autologous (using their own stored blood) or designated donor blood prepared in advance in case an emergency transfusion is necessary. Patients are encouraged to consult with their doctor regarding these issues if they are interested.

Chronic nasal drainage or excessive dryness or crusting of the nose.

Need for further and more aggressive surgery.

Need for allergy evaluation, treatments, or environmental controls. Surgery is not a cure for or a substitute for good allergy control or treatment.

Failure to improve or resolve concurrent respiratory illness such as, but not limited to, asthma, bronchitis, or cough.

Failure to resolve associated "sinus or nasal" headaches. The exact cause of headaches can be difficult to determine and may have many different causes that are not sinus-related.

The patient or physician may require consultation with another specialist such as a neurologist.

Damage to the eye and its associated structures.

Damage to the skull base with resultant meningitis, brain abscess, or leakage of spinal fluid.

What happens before sinus surgery?

In most situations, the surgery is performed as an outpatient at either the
hospital or a surgical center (surgicenter). In both facilities, quality care can be
provided without the inconvenience of an overnight stay. An anesthesiologist
will review the patient's medical history before surgery, and will monitor the
patient throughout the procedure. If the doctor has ordered pre-operative
laboratory studies, the patient should arrange to have these done several days in
advance, and bring all lab results to the hospital the day of surgery for
review.

Arrange for someone to spend the first night after surgery with the patient,
if possible in case the patient needs to remain overnight.

After surgery, the doctor will usually advise the patient to start using
saline irrigation. There are many different ways to irrigate the sinuses;
depending on the surgery that was performed, the surgeon will advise the patient
on the best method for this to be done.

In general, patients that have sinus surgery should not take
aspirin, or any
product containing aspirin, within 10 days prior to the date of surgery.
Nonsteroidal anti-inflammatory medications (such as Advil) should not be taken
within 7 days of the date of surgery. Many
over-the-counter products contain
aspirin or Advil-like drugs. Therefore, it is important to check all medications
carefully. If there is any question please call the doctors that prescribed the
medications (surgeon, primary care physician, cardiologist or other specialists)
or consult your pharmacist. Depending on the planned surgery, the surgeon may
have the patient refrain from such medications for a longer period of time.
Acetaminophen (Tylenol) is an acceptable pain reliever. Usually the surgeon will
give prescriptions for post-surgery pain medications at the preoperative visit.
It is best to have these filled prior to the date of surgery.

In most pre-operative preparations, patients must not eat or drink anything 8
hours prior to the time of surgery; the surgeon or hospital/surgicenter will let
the patient know the specific details regarding what time to stop eating and
drinking. This includes even water, candy, or chewing gum. Smokers should make
every effort to stop smoking, or at least reduce the number of cigarettes as
much in advance of surgery as possible. This will help to reduce postoperative
coughing and bleeding.

If a person is sick or has a fever the day before surgery, they should inform
the surgeon. If a patient wakes up sick the day of surgery, still proceed to the
surgical facility as planned. The surgeon and the anesthesiologist will
decide if it is safe to proceed with surgery.

What takes place the day of sinus surgery?

It is important that patients know precisely what time they are to check-in
with the surgical facility, and that they allow sufficient preparation time.
Bring all papers and forms, including any preoperative orders and history
sheets.

Patients should wear comfortable loose fitting clothes which do not have to
be pulled over their head. Leave all jewelry and valuables at home, including
ear rings, watches, rings, etc. Remove all make-up with a cleansing cream.
Patients should thoroughly wash their face with soap and water. Do not apply
make-up or cream to the face. If possible, avoid using hair clips or other
materials to hold up hair.

Do not take any medication unless instructed by the doctor or the
anesthesiologist. Usually, in the pre-operative holding room, a nurse will start
an intravenous infusion line (IV) and the patient may be given a medication to
help them relax.

What happens during sinus surgery?

In the operating room, the anesthesiologist will usually use a mixture of a
gas and an intravenous medication to put the patient to sleep and to maintain
anesthesia at a safe and comfortable level. During the procedure, the patient
will be continuously monitored. The surgical team is prepared for any emergency.
In addition to the surgeon and the anesthesiologist, there will be a nurse and a
surgical technician in the room. The whole procedure usually takes several
hours. The surgeon will come to the waiting room to talk with any family or
friends once the patient is safely in the recovery room.

What happens after sinus surgery?

After surgery, the patient will be taken to the recovery room where a nurse
will monitor the patient's vital signs. Usually, patients will be able to go home
the same day as the surgery once they have fully recovered from the anesthetic.
This usually takes several hours. Patients will need a friend or family member
to pick them up from the surgical facility. Someone (a responsible adult)
should spend the first night after surgery with the patient in case any
post-surgical problems develop.

On arrival at home from the surgical facility, the patient should go to bed
and rest with their head elevated on two to three pillows. By keeping the head elevated
above the heart, edema and swelling from the sinus surgery can be minimized.
Patients may get out of bed with assistance to use the bathroom but should avoid
straining with bowel movements because this may cause some surgical site
bleeding. If the person is constipated, they should take a stool softener or a
gentle laxative.

Some patients may have noticeable swelling of the nose, upper lip, cheeks, or
around the eyes for several days after surgery. This swelling is normal and will
gradually go away. People can help reduce it by putting an ice-pack on the face,
bridge of the nose, and eyes as much as tolerated. This will also help with
postoperative edema and pain. Some patients have found frozen vegetables in
packages (for example bags of frozen peas) to be a convenient ice pack which
nicely conforms to the face. The frozen material should be separated from the
skin by a towel or similar barrier to avoid any skin damage. Many clinicians
suggest periods of 15 minutes of such ice-pack treatment followed by 15 minutes
of removal to not damage the skin.

Moderate bleeding from the nose is normal, and will gradually decrease. The
gauze dressing ("mustache dressing") will collect blood and should be changed as
needed. It is not unusual to change these dressings every hour during the first
24 hours after surgery. It is recommended to purchase gauze pads prior to
surgery so that the patient will have enough for dressing changes. After a few days
the patient will probably not need to use the
dressing any longer. Do not take aspirin, aspirin-containing medications, or
nonsteroidal anti-inflammatory medications (such as ibuprofen/Advil, Naprosyn,
and others) for as long as the surgeon has instructed following surgery, because
such medications may increase bleeding and slow clotting at the surgical
site.

It is best to eat a light, soft, and cool diet as tolerated once the patient
has recovered fully from the anesthetic. Avoid hot liquids for several days.
Even though people may be hungry immediately after surgery, it is best to go
slowly to prevent postoperative nausea and vomiting. Occasionally, patients may
vomit one or two times immediately after surgery. If vomiting persists, please
contact the surgeon; the doctor may prescribe medication to reduce or eliminate
vomiting. It is important to remember that a good overall diet with ample rest
promotes healing.

Patients may be prescribed antibiotics after surgery, and should finish all
the pills that have been ordered. Some form of a narcotic may also be prescribed
and is to be taken as needed for pain. If the patient requires narcotics, they
should not drive and should consider having a responsible person stay with them.
In some situations the doctor may give steroids to be taken either
preoperatively and/or postoperatively. It is very important that the take this
medication as prescribed, and not discontinue it prematurely. The steroids are
instrumental in facilitating proper healing. If patients have any questions or
they feel that they are developing a reaction to any of these medications, he or
she should consult their doctor immediately. Patients should not take any
other medication, either prescribed or over-the-counter, unless they have
discussed it with the doctor.

How long will it take to recover from sinus surgery?

Depending on the extent of the surgery, recovery may take a few days. It may
take up to 3 to 5 days to feel completely back to normal. Patients should refrain
from activities that increase heart rate or blood pressure such as
running,
exercising, weight lifting, or other similar activities. It is imperative to
obtain guidance from the surgeon as to when they may resume all normal
activities. Until this time, patients should rest and limit physical
exertion.

General instructions and follow-up care for
sinus surgery

In many cases, packs or nasal packing is placed in the nose to control
postoperative bleeding. The surgeon will tell the patient when to return to the
office to have these packs removed. Patients may need to call the office to
schedule this postoperative appointment. Please arrange for someone to drive the
patient to and from the office for this first visit in case any complications
(for example, additional bleeding) develop. Patients should eat a light meal
before coming, and avoid taking excessive pain medications. In addition, most
patients will also have several subsequent office visits scheduled to assess
healing, remove crusts, and insure a speedy recovery. These visits are very
important as the surgeon may use the endoscope (camera to look in the nose) to
clean up the sinuses and perform further debridement if necessary. This post-operative
surveillance by the surgeon is very crucial in the individual's long-term
success with the surgery.

After the packing has been removed, individuals may breathe through their
nose, but should not blow or sneeze through it for 7 to 10 days to reduce the
chance of bleeding. If a person must sneeze, they should try to sneeze through
an open mouth. Many surgeons tell patients to expect some light blood-tinged
drainage from the nose for several days. If bleeding becomes excessive, apply an
ice-pack (described previously) and rest quietly with head elevated while applying
mild to moderate pressure to the nose. If bleeding continues, call the doctor's
office.

One of the most important things patients can do after surgery is nasal
irrigation. Immediately after the nasal packs are removed patients should use a
saline nasal spray such as "Ocean Spray" several times per day to prevent crusts
from forming in the nose. The surgeon will tell patients when to discontinue the
nasal spray and will also let them know the best way to irrigate the sinuses.

Patients should go back to work or school only when the doctor says you can
and should plan on resting for several days following surgery. Avoid excessive
talking, smiling, hard chewing, strenuous activities, and lifting heavy objects,
bumping the nose, and bending over. Try not to rest eye glasses on the bridge of
the nose until soreness and swelling subside. People may wear contact lenses
once eye swelling and any eye irritation has resolved. Alcohol and tobacco
should be avoided because they may prolong swelling and healing. Smoke, dust,
and fumes may irritate the nose and cause an infection. In general, people may
use usual make-up any time after surgery, as long as the structures (for example,
eyelids) with make-up are relatively normal and are not irritated by the
application of make-up. Be gentle while brushing the upper teeth. They will
often be tender for several weeks, and some people may have some numbness of the
teeth and palate for several months.

Patients should plan to remain in the general area where the surgery was
performed for 3 weeks to allow for postoperative care and in case bleeding
occurs, the patient can be seen by the surgeon that did the procedure and who
should best be able to treat the patient.

Persistent sharp pain or headache which is not relieved by the prescribed pain medication.

Increased swelling or redness of the nose or eyes.

Drainage of a thin, clear fluid in large quantities from usually only one side of the nose. This would be different from the clear, thicker mucus drainage normally produced by the nose.

Self-Care and prevention after sinus surgery

It is important for all patients with chronic sinus disease to understand
that they have a chronic illness. Successful sinus surgery will only help
control the complications and discomfort of chronic sinus disease. The following
three areas of prevention should always be remembered:

Maximize Moisture. Patients should always remember to maximize moisture in
their nose. Keeping sinuses moist makes mucus thinner, allowing the sinuses to
drain better. This drainage in turn helps prevent infection. Use a humidifier,
drink plenty of water, avoid drying substances such as alcohol and caffeine, try
to avoid smoke which dries out sinus linings, and use plenty of saline
irrigation.

Avoid Allergy Particles (Allergens). People may want to wear a mask when
they clean or are exposed to dust. Sit in the non-smoking sections of
restaurants. Avoid exposure to pollens during peak season, and keep an
air-conditioner on during allergy season.